Summary & Overview
HCPCS A5513: Custom Diabetic Total-Contact Multiple Density Foot Insert
HCPCS Level II code A5513 denotes a custom-molded, multiple-density total-contact foot insert specifically for patients with diabetes. These custom-fabricated orthotic inserts include arch filler and shaping materials, with a minimum 3/16-inch base layer of at least Shore A 35 durometer. As a clinically targeted device, code A5513 supports diabetic foot care strategies aimed at pressure redistribution and ulcer prevention for neuropathic or high-risk feet.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, coding and billing context, and clinical indications that inform payer policy. Readers will find benchmarks on utilization and reimbursement practices, summaries of relevant policy updates affecting coverage for custom diabetic orthoses, and clinical context describing when a custom total-contact insert is used versus prefabricated alternatives.
This content is written for a national audience of clinicians, billing professionals, and policy analysts. It highlights what A5513 represents in practice, typical service settings where the device is fabricated and dispensed, and the key considerations payers use when determining medical necessity and coverage.
Billing Code Overview
HCPCS Level II code A5513 describes a custom-molded, total-contact multiple density insert specifically for patients with diabetes. The item is custom fabricated from a model of the patient's foot, provides total contact including the arch, and includes an arch filler and other shaping materials. The base layer is a minimum of 3/16 inch material with a Shore A durometer of 35 (or higher). The description indicates this is a single, custom orthotic insert provided each.
Service type: Custom diabetic therapeutic foot orthotic insert (total-contact, multiple density, custom fabricated)
Typical site of service: Outpatient orthotics/prosthetics clinic, podiatry clinic, durable medical equipment supplier, or other ambulatory care setting where custom foot orthoses are fabricated or dispensed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with long-standing type 2 diabetes mellitus and peripheral neuropathy presents to a podiatry clinic complaining of recurrent forefoot pressure points and callus formation with early plantar ulceration on the metatarsal heads. After a comprehensive diabetic foot exam, gait analysis, and assessment of foot biomechanics, the podiatrist determines the patient will benefit from a custom molded total contact diabetic insert with multiple density materials and arch support. The clinical workflow: initial evaluation and documentation of diabetic foot risk and wound status; taking a cast or digital model of the patient’s foot to capture total contact including the arch; fabrication order transmitted to an orthotic laboratory specifying a base layer of at least 3/16 inch Shore A 35 durometer or higher, arch filler and shaping materials; delivery and fitting of the custom insert at a follow-up visit with patient education on wear schedule and skin inspection; documentation of fit and patient tolerance. Typical sites of service include outpatient podiatry clinics, specialty orthotics/ prosthetics centers, and ambulatory surgery or wound care centers when fabrication is coordinated with other procedures. Common payors for authorization and payment interactions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the insert is for the left foot |